Introduction:
Periodontal diseases are a group of inflammatory processes that affect
the tooth-supporting structures which, if left untreated, can progress
and cause bone loss, thereby impairing the survival of the teeth.1-3. Maxillary molars are the most commonly lost
teeth, followed by the mandibular molars. 4,5
Treatment of periodontal disease focuses mainly on arresting disease
progression and preserving the form and function of the dentition
involved. Managing periodontal disease around multirooted teeth is
challenging for periodontists because of the complex anatomy of the
tooth furcation area, which favors plaque accumulation and hinders
personal and professional cleaning attempts. The furcation is defined as
the anatomic area of a multirooted tooth in which the roots diverge, and
pathologic resorption of the bone in this region is known as “furcation
involvement.” 6
Furcation involvement is associated with a poor prognosis and higher
tendency for tooth loss 4 due to the complex anatomy7,8 9 and difficulty in maintaining
oral hygiene, performing periodontal debridement10-13, and periodontal maintenance5. Several treatment options have been proposed to
manage furcation involvement by cleaning the area and rendering it more
cleansable. Treatment options vary according to the degree of furcation
involvement and patient- and clinician-related factors and include
simple debridement of the defect using either closed or surgical
approaches; furcation plasty/osseous plasty; regenerative approaches
involving guided tissue regeneration around the furcation; and resective
approaches involving tunneling 14, root
resection/amputation, or hemisection. In case of failure of these
options, tooth extraction is necessary.
Root amputation and hemisection are the least desired approaches by both
patients and clinicians because of the assumption of inferior results
compared with other therapies, such as dental implants. However, this
assumption is contrary to the findings in several studies that reported
high success rates when these procedures were performed correctly on
properly selected patients. Herein, we present the 14-year follow-up of
a maxillary right first molar (tooth #16) in which root amputation was
performed and explain how this procedure saved the tooth during cancer
treatment.
Case history: A 33-year-old woman was referred to our
periodontal department by a prosthodontist for surgical crown
lengthening of the endodontically treated tooth #16. The patient was
medically fit and did not smoke. Clinical examination revealed fair oral
hygiene with calculus deposition over the mandibular anterior teeth.
Periodontal evaluation revealed a localized deep periodontal pocket with
a probing depth (PD) of 6–7 mm distal to tooth #16 and distal grade 2
furcation involvement. 15 In addition, a periodontal
pocket with a PD of 4–5 mm and grade 1 furcation involvement distal to
tooth #26, 2 mm gingival recession around tooth #46 with lingual grade
2 furcation involvement, gingival recession on the lingual of the
mandibular anterior teeth and buccal of tooth #34 Recession type two
(RT 2) 16, and short anterior crowns were observed.
The patient had class 1 molar and canine relationships on both sides
according to Angle’s classification ( Figure 1).